Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 200783 | NY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 200783 | NY |
Y | 208200000X | Surgeon | 200783 | NY |
Y | 208600000X | Surgeon | 200783 | NY |
NPI | 1134297484 |
---|---|
Provider Name | Michael Jones |
First Address | Melville, NY 11747-4230 |
Second Address | Jamaica, NY 11418-2897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2006 |
Last Update Date | 18/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G97642 | (02) | NY |